266例黑甲性皮损的皮肤镜特点分析

【摘要】 目的 比较临床常见黑甲性疾病的皮肤镜表现及特点。方法 回顾性分析2016年1月至2020年7月在第四军医大学西京皮肤医院行皮肤镜检查的4种常见黑甲皮损皮肤镜图像特征。结果 共纳入266例黑甲性皮损，其中甲黑素瘤64例（24.1%），甲母痣52例（19.5%），甲下出血89例（33.5%），甲真菌病61例（22.9%）。甲黑素瘤及甲母痣多发于指甲，甲黑素瘤发生于拇指甲的比例高（62.8%），甲母痣则更多发生于2 ~ 5指甲（73.9%）；甲下出血及甲真菌病多发于趾甲，其中甲下出血51例（57.3%），甲真菌病46例（75.4%）。甲黑素瘤好发于40岁以上患者（49例，76.8%），其余3组疾病则多见于40岁以下患者。甲黑素瘤皮肤镜表现主要为纵向规则条带（35例，54.7%）或不规则条带（25例，39.0%），87.5%的病例色素带宽度大于3 mm， 36例（56.3%）Hutchinson征阳性， 15例（23.4%）破溃，颜色以黑褐色为主；甲母痣表现为单一规则色素带结构（52例，100%），36例（69.2%）色素带宽度小于3 mm，26例（50%）Hutchinson征阳性，无破溃病例；甲下出血表现为弥漫性斑疹（74例，83.1%），85例（95.5%）见暗红色或黑色出血小球结构；黑甲性甲真菌病表现为黑褐色纵向不规则条带（54例，88.5%）。结论 皮肤镜下，甲黑素瘤可表现为纵向规则条带，条带宽幅大于3 mm，甲母痣多表现为纵向规则条带，甲下出血表现为弥漫性污斑，甲真菌病可表现为纵行不规则条带。皮肤镜可用于鉴别黑甲性皮损，为甲黑素瘤辅助诊断提供依据。

Dermoscopic features of 266 cases of melanonychia

【Abstract】 Objective To investigate dermoscopic manifestations and features of melanonychia. Methods A retrospective analysis was carried out on dermoscopic images of 4 common types of melanonychia collected in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2016 to July 2020. Results A total of 266 cases of melanonychia were collected, including 64 （24.1%） of subungual melanoma, 52（19.5%）of nail matrix nevi, 89 （33.5%） of subungual hemorrhage, and 61 （22.9%） of onychomycosis. Subungual melanoma and nail matrix nevi mostly occurred in the fingernails. To be specific, subungual melanoma most frequently occurred in the thumbnails （62.8%）, while nail matrix nevi mostly involved the 2nd - 5th fingernails （73.9%）. Subungual hemorrhage and onychomycosis mostly occurred in the toenails, and there were 51 （57.3%） cases of subungual hemorrhage of the toenails and 46 （75.4%） cases of onychomycosis of the toenails. Subungual melanoma mostly occurred in patients aged over 40 years （49 cases, 76.8%）, while the other 3 types of melanonychia mostly affected patients aged under 40 years. Dermoscopic manifestations of subungual melanoma mainly included regular longitudinal bands （35 cases, 54.7%） or irregular bands （25 cases, 39.0%） whose width was greater than 3 mm in 87.5% cases, Hutchinson sign （36 cases, 56.3%）, and ruptures （15 cases, 23.4%） which mainly were black-brown in color; dermoscopic manifestations of nail matrix nevi mainly were a single regular pigmented band （52 cases, 100%） whose width was less than 3 mm in 36 （69.2%） cases, and Hutchinson sign （26 cases, 50%）, while no ruptures were observed in nail matrix nevus lesions; subungual hemorrhage dermoscopically manifested as diffuse macules （74 cases, 83.1%）, and globular dark red or black hemorrhagic structures were observed in 85 （95.5%） cases; fungal melanonychia was dermoscopically characterized by irregular dark brown longitudinal bands （54 cases, 88.5%）. Conclusions Subungual melanoma was dermoscopically characterized by regular longitudinal bands with a width of greater than 3 mm, nail matrix nevi by regular longitudinal bands, subungual hemorrhage by diffuse macules, and onychomycosis by irregular longitudinal bands. Dermatoscopy can be used to identify melanonychia lesions and provide a basis for auxiliary diagnosis of subungual melanoma.